FEDERAL MINISTRY OF WATER RESOURCES MAKING NIGERIA OPEN-DEFECATION-FREE BY. A National Road Map. European Union. from the British people

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1 ITY UN & FAIT H, PEACE & PRO G RE SS FEDERAL MINISTRY OF WATER RESOURCES MAKING NIGERIA OPEN-DEFECATION-FREE BY A National Road Map European Union from the British people

2 Contents ACRONYM FOREWORD PREFACE EECUTIVE SUMMARY SECTION I: SANITATION SITUATION IN NIGERIA - General Background SECTION II: PAST EFFORTS TO PROMOTE SANITATION - Water-Sanitation Policy National Task Group on Sanitation - Establishment of RUWASSA and WASH Departments/Units - Government efforts to meet MDG - CLTS Approach to Sanitation iv v vi vii SECTION III: RATIONALE FOR A ROAD MAP A. Benefits of Sanitation - The health perspective - The nutrition perspective - The learning-outcome perspective - The social perspective - The economic perspective - The marketing perspective B. Nigeria lagging behind the milestones set by the National Water-Sanitation Policy, 2004 C. Apprehension on meeting the Open-Defecation-Free Nigeria by 2025 and SDG-6 14 D. Challenges ahead 14 E. Lessons learnt from past efforts and problems associated with slow progress in sanitation coverage SECTION IV: SUGGESTED ROAD MAP AND STRATEGIES - Technology options to suit different geo -physical conditions - Technology options to suit household s preferences and paying capability - Sanitation ladder - Pour-flush toilets using less water as a low cost option - Appropriate delivery mechanism and social marketing of sanitation - Refocusing the triggering process under CLTS - Need for developing relevant IEC materials and using appropriate mass media - Rural vs Semi-urban and Urban areas - Toilets in public places - Training of personnel - Administrative back up and coordination mechanism - Certification for open defecation free communities and beyond i

3 SECTION V: PHASING FOR IMPLEMENTING THE ROAD MAP (State of preparedness and A period of Transition) (Assessment) (Years of consolidation and moving forward) (A year of self-assessment) (The final assault) 44 - Breakdown of targets 44 SECTION VI: ENABLING ENVIRONMENT TO SUPPORT ELIMINATION OF OPEN DEFECATION 45 SECTION VII: MAJOR ROLES AND RESPONSIBILITIES OF KEY STAKEHOLDERS A. National level - Federal Ministry of Water Resources - Federal Ministry of Environment - Federal Ministry of Health - Federal Ministry of Education - Federal Ministry of Housing and Urban Development - Federal Ministry of Women Affairs - NTGS B. State level C. C. Donor/UN Agencies/International NGOs D. D. NGOs/CBOs SECTION VIII: IMPLEMENTATION PLAN 54 SECTION I: INVESTMENT NEEDS AND ALIGNMENT WITH MDG 6.2 AND PEWASH ( ) 61 - Investment 61 - Return on Investment 62 TABLES Table - 1: Basic Socio-Economic Indicators across Regions in Nigeria Table - 2: Use of sanitation facilities in Nigeria Table - 3: Region-wise progress of CLTS implementation Table - 4: Enabling factors influencing implementation of road map/strategy Table - 5: Activity plan for the implementation of the proposed road map/strategy FIGURES Figure - 1: Geo-physical regions of Nigeria Figure - 2: Change in type of sanitation facilities used by households in Nigeria ( ) Figure - 3: Distribution of income in Nigeria Figure - 4: The sanitation ladder Figure - 5: Sketch of single pour-flush latrine Figure - 6: Sketch of dual pit pour-flush latrine ii

4 ANNEES Annex - 1: Status of CLTS implementation in Nigeria Annex - 2: List of materials to be kept in a Sanicentre/SM/SRC/SH Annex - 3: One-day programme of the community contact team REFERENCES APPENDI: List of Contributors iii

5 Acronyms BCC: CCD: CCT: CHEO: CLTS: DfID: DPHE: EHO: EU: FCT: FMWR: FME: FMEdn.: GDP: IDA: IYS: JMP: KAP: LGA: MDG: MICS: NDHS: NGN: NGO: NTGS: NWRI: ODF: PHC: RSC: RSM: RUWASSA: SEPA: SH: SM: SMSU: SPC: SRC: STGS: SUBEB: UN: UNICEF: WHO: VHP: VIP: WASH: WASHCOM: WSP: Behavioural Change Communication Community Contact Drive Community Contact Team Community Health Extension Worker Community Led Total Sanitation Department for International Development Department of Public Health Engineering Environmental Health Officer European Union Federal Capital Territory Federal Ministry of Water Resources Federal Ministry of Environment Federal Ministry of Education Gross Domestic Product Iron Deficiency Anaemia International Year of Sanitation Joint Monitoring Report Knowledge, Attitude and Practice Local Government Area Millennium Development Goal Multi Indicator Cluster Survey National Demographic and Health Survey Nigerian Naira Non-Governmental Organization National Task Group on Sanitation National Water Resources Institute Open Defecation Free Primary Health Centre Rural Sanitation Centre Rural Sanitary Mart Rural Water Supply and Sanitation Agency State Environment Protection Agency Sanitary Hub Sanitary Mart Sanitary Marketing Scaling Up Sanitation Promotion Centre Sanitary Resource Centre State Task Group on Sanitation State Universal Basic Education Board United Nations United Nations Children Fund World Health Organization Voluntary Hygiene Promoter Ventilated Improved Pit Water Sanitation and Hygiene Water, Sanitation and Hygiene Committee Water and Sanitation Programme iv

6 Foreword Nigeria is among the nations in the world with the highest number of people practicing open defecation, estimated at over 46 million people. The practice has had a negative effect on the populace, especially children, in the areas of health and education and had contributed to the country s failure to meet the MDG target. The sanitation situation in the country prompted the National Council on Water Resources in 2014 to prioritize the development of a roadmap towards eliminating open defecation in the country, in line with the United Nations global campaign for ending open defecation. This initiative tagged Making Nigeia Open Defecation Free by 2025: A National Roadmap was developed by the Federal Ministry of Water Resources with invaluable support from UNICEF and other key sector players across Nigeria. In 2016, the National Council on Water Resources endorsed this road map as a mean to eliminate open defecation in Nigeria. The Roadmap provides a guide towards achieving an open defecation free country using different approaches such as capacity development; promotion of improved technology options through sanitation marketing; provision of sanitation facilities in public places; Community-Led Total Sanitation; promotional and media campaigns; creating enabling environment and coordination mechanism. In this strategy document an indicative investment required for achieving the roadmap is estimated, showing the cost by government at all levels and the private sector, especially for construction of sanitation facilities in public places and the cost by households for construction of household sanitation facilities. I am glad to stress that the cost benefit of investment in sanitation on the health, economic and education sectors cannot be overemphasized as reduction in diarrhea diseases among children, increased school attendance, reduction in health care cost and job creation for sanitation services will contribute to economic growth and development. The Roadmap also provides a basis for the development of the Partnership for Expanded Water Supply and Sanitation (PEWASH) programme which aims to establish a multi-sectoral partnership between government, development partners and the private sector to support the empowerment of rural dwellers in Nigeria through the provision of adequate water supply and sanitation services. The Federal Ministry of Water Resources will provide the enabling environment, leadership and coordination required in achieving this target by working together with communities, civil society, development agencies, private sector and government at sub-national levels. Engr. Suleiman H. Adamu FNSE Honourable Minister, Federal Ministry of Water Resources, Abuja v

7 Preface Iimproved sanitation and hygiene practices is fundamental to child survival, socio-economic development and wellbeing of the society at large. Eliminating open defecation has benefits from the health, nutrition, learning, social and economic perspective. In addition it safeguards girls/women's dignity and protects them against sexual harassment, while they are out to relieve themselves. Access to improved sanitation in Nigeria has declined over time. Between 1990 and 2015, the WHO- UNICEF Joint Monitoring Program data reveals an 8% decrease in access to sanitation in rural areas and 3% decrease in access to sanitation in urban areas. The decline in access is further pronounced for the poorest. Nigeria was significantly off track with regard to the MDG-7 target on sanitation. As a result there are over 70 million people without access to improved sanitation and more than 45 million people practicing open defecation in Nigeria. Recognizing the public health risks, the National Council on Water Resources at the 2014 council meeting recommended the development of an Open Defecation Free (ODF) Roadmap for Nigeria. The present ODF Roadmap is an attempt to clearly articulate the strategies, plans and investments needed to eliminate open defecation by Achieving an ODF environment implies having access to toilets not only in the communities but also within schools, health centres, markets and other public places. The roadmap is organized into nine sections encompassing current sanitation situation, past efforts and lessons learned in the implementation of sanitation programmes, rationale, suggested strategies and action plan, phasing for implementing the road map, roles and responsibilities of key stakeholders, implementation plan, the required enabling environment and investment needs for eliminating open defecation by Community Led Total Sanitation (CLTS) has proven to be an effective approach towards accelerating sanitation access in the country having exponentially grown from a mere 15 ODF communities in 2008 to over 14,000 ODF communities in The expansion of CLTS program has led to a growing pool of trained CLTS facilitators and has improved the quality of triggering and ODF certification process. In terms of providing the enabling environment for the implementation of the ODF road map, the Ministry of Water Resources has clearly prioritized elimination of open defecation in its recently launched Partnership for Expanded WASH (PEWASH) program. The ODF roadmap is an actionable costed plan to achieve PEWASH targets on sanitation as well as the attainment of SDG-6.1 target. Achieving an ODF Nigeria would require constructing nearly 20 million household toilets and 43,000 toilets in schools, health centres and public places requiring an average annual investment of about NGN 100 billion (approximately 75% household investment; 25% government contribution). The implementation of the roadmap will be in phases the initial preparatory phase, followed by the consolidation phase and the final assault phase as we approach We sincerely commend the efforts and the contributions made by Bidhu Bhushan Samanta, the international consultant engaged to lead the development of this roadmap. We would also like to place on record the contributions made by the members of the National Task Group of Sanitation, CLTS practitioners across the country and the development partners. Emmanuel Olusola Awe Director, Water Quality Control & Sanitation Department Chairman, National Task Group on Sanitation Federal Ministry of Water Resources, Abuja Kannan Nadar Chief of Water, Sanitation & Hygiene UNICEF Nigeria Country Office Abuja Chair of WASH Development Partner s Group vi

8 Executive Summary The Government of Nigeria is committed to end open defecation in the country by 2025 which is in line with the revised global target set by the United Nations. Towards this end, FMWR requested UNICEF, Nigeria to undertake the development of a road map for making Nigeria open-defecationfree by 2025.The present exercise is the outcome of this resolve. Presently (2015) around 46 million people in Nigeria defecate in the open. Another 56 million people are estimated to be added during the next ten years. This means a total of 102 million people or 20 million households should have access to a toilet and use it. Besides, sanitation facilities have to be provided to numerous institutions such as schools, health centres, market centres, motor parks, highway eateries, jetties and religious places so as not to have any open defecation around these places. The adverse impact of open defecation is now well documented. According to a World Bank Report (2012), around 122,000 Nigerians including 87,000 children under 5 die each year from diarrhoea; nearly 90% is directly attributed to water, sanitation and hygiene. A very comprehensive review of 21 studies, covering several countries found out a 36% reduction in diarrhoeal morbidity due to improved sanitation. According to the NDHS (2013), 37% of Nigerian children, under 5 were stunted (height for age), 18% wasted (weight for height) and 29% under-weight (weight for age). According to the same study while the percentage of stunted children declined between 2003 and 2013, there was an increase in the percentage of wasted and under-weight children. Studies have shown that a large part of malnutrition burden owes to the unhygienic environment in which the children grow up. One of the major reasons for iron deficiency anaemia (IDA) among adolescent girls and young mothers is found to be worm infestation that is attributed to open defecation. An anaemic mother, in all probability, will deliver a low-birth-weight baby not only endangering the life of the new born but also the mother. It is, therefore, not surprising that one in every fifteen Nigerian children dies before reaching his/her first birth day and one in every eight does not survive to see his/her fifth birth day. Open defecation is not only a social stigma but also a factor contributing to violence against young girls and young married women. As per a study sponsored by Water Aid in selected slums in Lagos, a quarter of women, defecating in open, had either first or second hand experience of harassment, a threat of violence or actual assault in the previous 12 months and over two-thirds felt unsafe using a shared or community toilet in a public place. As per a World Bank Report (2012), Nigeria loses NGN 455 billion or US$ 3 billion annually due to poor sanitation. This works out to US$ 20 per capita/year and constitutes 1.3% of Nigeria's GDP. According to the same report open defecation alone costs Nigeria over US$ 1 billion a year. The market potential of sanitation in the country is huge. If the 46 million people that defecate in the open at present opt for a toilet, the demand for material and labour, on a conservative estimate, will work out to NGN 1250 billion or over US$ 8 billion. The road map proposed in this report examines the justification for an open-defecation-free Nigeria, assess the adequacy of the steps taken in the past and the strategies needed to achieve the goal. This has been done through a set of strategies and action points. These strategies and action points relate to i) technology options to suit different geo-physical conditions, ii) technology options to suit vii

9 households' preferences and paying capability, iii) developing and promoting a 'Sanitation Ladder', iv) promoting low-cost and low-water consuming pour flush latrines, v) developing an appropriate alternate delivery mechanism and social marketing for sanitation, vi) refocusing the triggering process under CLTS, vii) developing relevant IEC materials and using appropriate mass media, viii) addressing the special needs of semi-urban and urban areas, ix) providing toilet facilities at public places, x) training of personnel and human resources development, xii) administrative back up and coordination mechanism and xiii) modification of the certification for ODF and beyond. A time plan for implementing the proposed road map has been prepared. The various time lines suggested are, state of preparedness and period of transition ( ), assessment (2018), years of consolidation and moving forward ( ), year of self-assessment (2022) and the final assault ( ). Suggestions have been made to phase out the targets set, in terms of population to be covered. The yearly targets set were 4.3 million population during , 8.6 million population during and million during with the exception of 2025 during which million is targeted. In order to achieve the targets, the road map has also come out with a bottleneck analysis and a set of enabling environment. Such analysis relate to, i) political will, ii) legal framework, iii) policy on sanitation, iv) long-term vision with an investment plan, v) need-based budgeting, v) well-defined organizational structure, vi) proper programming and investment plan, vii) a robust review and monitoring system, viii) effective coordination among stakeholders, ix) a strong network of CSOs/NGOs and CBOs and x) a responsive private sector. An exhaustive list of activities under each of the strategies has been identified keeping in mind the time line proposed for implementation of the proposed road map. Ministries/Departments/agencies to be responsible for these activities have also been identified. The road map has also worked out the indicative investment for making the country open-defecationfree by The total investment estimated works out to NGN 959 billion. Of this NGN, 725 billion will be the share of household latrines that will be totally met by them. The share of Government (National, State and LGA) will be in the order of 234 billion or around 23.4 billion per year. In terms of US$ it works out to around 150 million per year or less than one US$ per capita/year. In view of the fact that Nigeria loses NGN 455 billion each year (equivalent of US$ 3 billion or US$ 20 per capita/year), the investment proposed is justified. Even if the entire cost of NGN9.59 billion is taken into account, still an open-defecation-free Nigeria can pay back more than what has been invested. viii

10 MAKING NIGERIA OPEN-DEFECATION-FREE BY 2025 A National Road Map

11 SECTION I: SANITATION SITUATION IN NIGERIA General Background: Nigeria is one of the West African countries and is located on the gulf of Guinea. With a total area of 923,768 square kms. It is world's 32nd largest country, after Tanzania. However, in terms of population, Nigeria is the most populous country of Africa. The population of Nigeria, as per the National Population Commission, is around1 83 million (2015 projection) spread over its 36 States and Federal Capital Territory (FCT), 774 Local Government Areas (LGAs), 9522 wards and around 123,240 communities. The population growth rate is a little over 3% per annum. The country's most expansive topographical region is that of the valleys of the Niger and Benue River. These two rivers converge and empty into the Niger Delta which is one of the world's largest river deltas and the location of a large area of Central African Mangroves. While on the south-west of Niger is a rugged highland, on the south-west of Benue are hills and mountains; the latter forms the Mambila Plateau. Nigeria is a heterogeneous country of more than 250 ethnic groups. The country is divided into six geo-political zones viz., North West, North East, North Central, South East, South South and South West. The States falling under each of these regions are given below. Their location can be seen from Map-1 North-East: Yobe, Borno, Bauchi, Gombe, Adamawa and Taraba North-West: Kebbi, Sokoto, Zamfara, Katsina, Kaduna, Kano and Jigawa North-Central: Niger, Kwara, Kogi, Nasarawa, Benue, Plateau and FCT-Abuja South-East: Enugu, Imo, Anambra, Abia and Ebonyi South-West: Oyo, Osun, Ekiti, Ogun, Ondo and Lagos South-South: Edo, Delta, Bayelsa, Akwa Ibom, Rivers and Cross-River 2

12 These regions show wide socio-economic divergence (Table -1). Table -1 Basic Socio-economic Indicators across Regions in Nigeria Indicators North North North South South South National Rural Urban -East -West -Central -East -West South Poverty Incidence (%) Health Access (%) Infant Mortality U-5 Morality Rate Safe Water Source (%) Safe Sanitation (%) Improved Waste disposal (%) Diarrhoea incidence (%) Source: National Bureau of Statistics, Annual Abstract of Statistics 2007 Over all the North-East, North-West and North-Central regions have higher incidence of poverty, higher infant mortality and under five mortality rates, less access to safe water and sanitation (except for North-West with regard to sanitation). Regions in the South seem to be in a more advantageous position in terms of socio-economic development. There is no significant change in the situation over the years. National Scene: Sanitation coverage, in terms of access to latrine, is available from more than one source with different figures. Notwithstanding these deviations it can be concluded that access to latrine in Nigeria is far from satisfactory. According to the 2003 National Demographic and Health Survey (NDHS), around 18 percent of households in Nigeria used improved sanitation facility like flush toilet or VIP, over 56 percent used traditional pit latrines and 26 percent had no access to sanitation facility forcing them to go for open defecation. In rural areas close to one-third of the households were practising open defecation. The same source for 2013 indicates an increase in the percentage of households (29%) reporting open defecation although there was a decrease in the percentage of households using traditional pit latrine (37%) and an increase in the use of improved sanitation facility (30%). A more comprehensive data on the use of sanitation facilities by population is available from the JMP on Drinking Water and Sanitation brought out by WHO and UNICEF annually and the latest NDHS carried out in A time- series data available from 1990 through 2015 indicate a marginal decline in the use of improved sanitation facilities (from 38% to 29%) and a slight increase in open defecation from ( 24% to 25%). At the same time, use of shared and other unimproved latrines has increased from 38% to 46%). 3

13 M A K I N G N I G E R I A O P E N - D E F E C AT I O N - F R E E BY NIGERIA Figure -1 Geo-Political Regions of Nigeria North West Zone North East Zone NorthCentral Zone South West Zone South South Zone South East Zone While this trend holds good for rural areas, in urban pockets, use of improved sanitation facilities has gone up from 36% to 43% (Table -2). Nevertheless, open defecation in urban areas shows a significant increase during the same period (from 7% to 15%). The above analysis brings out two points. One, the increase in the population using a latrine (any type) has not kept pace with the population growth that is currently estimated at over 3% annually and second, climbing up the 'Sanitation Ladder' has yet to pick up in the country. 4

14 Table - 2 Use of Sanitation Facilities in Nigeria: (% of population ) Facility National Improved Shared Other unimproved Open defecation Urban Improved Shared Other unimproved Open defecation Rural Improved Shared Other unimproved Open defecation Source: JMP Reports of WHO and UNICEF, 2010, 2011, 2012, 2013 and 2015 NDHS, Nigeria, 2013 Figure - 2 Change in type of sanitation facilities used by households in Nigeria ( ) Source: JMP Reports of WHO and UNICEF 2010, 2011, 2013 & 2015 and NDHS,

15 Situation in States and FCT: Use of sanitation facilities in different States and the FCT is available only for 2011 from the results of MICS. This may not give a correct picture for all states due to the implementation of CLTS. In many of the donor funded States sanitation coverage would have jumped significantly over the last two years due to the Community-led Total Sanitation (CLTS) approach. Nevertheless, it does give an idea about the degree of variation among the different States and among the different segments of the population as may be seen below. - The extent of open defecation varies from as low as 1.2% of households in Abia to as high as 65.8% in Kogi. Other States that show higher than the national average (37%) with regard to open defecation practices are Ekiti (60.8%), Plateau (56.2%), Oyo (54.0%), Cross River (53.6), Benue (52.9%), Taraba (52.5%), Nasarawa (50.8%), Kwara (50.5%, Enugu (48.6%), Jigawa (48.1%), Ondo (47.6%), Niger (47.5%), Ebonyi (45.5%), Osun (39.2%) and Kebi (37.6%) - In urban areas the most popular toilets used are flush to septic tank or to a pit. In rural areas pit latrines without slab or open pit are more in vogue. - It appears use of improved latrine facilities are strongly related to the economic status of a household. Thus while 95% of the richest households use improved latrines the same is only 12% among the poorest ones. - Use of improved latrines seems to move with the educational level of the head of a household. While the use of flush latrine connected to a septic tank is only 3% among those with no education, the same is over 27% where the head of the household had studied up to secondary education or higher. 6

16 SECTION II: PAST EFFORTS TO PROMOTE SANITATION The Government of Nigeria is committed to promoting sanitation and hygiene, along with drinking water. Towards this end, it has formulated policies and strategies from time to time. Some of these policies are i) National Water Supply and Sanitation Policy, 2000, ii) National Environmental Sanitation Policy, 2005, iii) National Health Promotion Policy, 2006 and iv) Strategy for Scaling up Rural Sanitation and Hygiene to meet MDG, Water-Sanitation Policy 2004 (Draft): The Draft National Water-Sanitation Policy developed by the Federal Ministry of Water Resources is the most comprehensive one that focuses on sanitation and hygiene including disposal of liquid and solid waste. Although it is yet to get approved by the Federal Executive Council, it does speak of the thinking on the subject and the spirit of making sanitation as an important component of the social sector programs in the country. The objective of this policy is to ensure that all Nigerians have access to adequate, affordable and sustainable sanitation through the active participation of Federal, State and Local Government, NGOs, development partners, private sector, communities, households and individuals. The draft has laid down the following milestones to achieve an open-defecation-free Nigeria by Thus, Nigeria was probably one of the few countries that were more practical to fix the target within a reasonable timeframe even in 2004, much before the UN revised the target of universal sanitation coverage by Review and improve coverage of sanitation to 60% of the population by Extension of sanitation coverage to 65% by Extension of sanitation coverage to 80% by Extension of sanitation coverage to 90% by Achieve 100% sanitation coverage by Sustain 100% sanitation coverage beyond 2025 The Policy had also laid down the service level for different areas viz., rural, semi-urban and urban (See Box). With regard to funding the Sanitation Program, the Policy envisaged that all tiers of the Government shall appropriate with timely release of a separate vote for sanitation of an amount which is equivalent to not less than 15% of their annual appropriation for water supply to implement sanitation programs. 7

17 Rural: Each household in rural areas (community of population less than 5,000) must own and have access to safe sanitary facility with at least minor improvements that would reduce flies, odour, etc (at least upgraded pit latrine) Semi-urban: Each household in semi-urban areas (population of 5000 to 20,000) must own and have access to safe sanitary facility that is adaptable to existing traditional pit latrine and uses superstructures which blends very well with other buildings within community (at least a Sanplat latrine) Urban: Each household in urban areas (population above 20,000) must have access to safe sanitary facility that uses suitable and affordable water conveyance systems (at least a pour- flush toilet) Subsequently, the Strategic Framework for the National Rural Water Supply and Sanitation Program 2005 envisaged the share of different stakeholders of sanitation program as follows: Federal Government: 5% States: 15% LGAs: 20% Communities: 60% (including full cost of latrines) The above arrangement did not define as to what component of the program each tier will fund. However, so far as household latrines are concerned, the entire cost of construction and their operation and maintenance was to be fully borne by a household irrespective of its socio-economic status. Thus the policy promoted a non-subsidy and demand driven approach to expand sanitation coverage. The policy advocated for promoting a range of options for upgrading the traditional pit latrines that can be called the 'Sanitation Ladder'. These were: - Upgraded traditional pit latrines by covering the pit opening/squat hole with a suitable cover, plastering of the latrine floor with cement and introduction of a vent pipe to improve the hygiene conditions of the latrine - Sanplat slab and vent - Ventilated Improved Pit Latrine (VIP) - Pour-flush toilet; the toilet could be squatting or sitting type - Septic tank/soak-away system, particularly for semi-urban and urban areas - Conventional sewerage system suitable for large cities National Task Group on Sanitation: The Government established a National Task Group on Sanitation (NTGS) with its Secretariat presently in the Federal Ministry of Water Resources (FMWR) in This is an inter-ministerial/agency group that include Federal Ministries of Water Resources, Environment, Housing and Urban Development, Health, Education, Women's Affairs, National Orientation Agency, MDG Office, National Planning Commission and National Agency for Food, Drug Administration and Control. Other members include UNICEF, Water Aid, European Commission, DfID, World Bank and NEWSAN. Later similar Task Groups were formed at State level. 8

18 Establishment of RUWASSA and WASH Departments/ Units: As a part of decentralizing the WASH Program and advocacy from agencies like UNICEF, some State Governments started establishing a full-fledged Rural Water Supply and Sanitation (RUWASSA) Agency by law followed by WASH Department or Units at LGA level for better planning and implementation of the Sanitation Program. This was more conspicuous in states having external funding from donors. States/LGAs where no full time RUWASSA or WASH Department/ Units exist, WASH matters are handled by either Health or Environment Department. Government efforts to meet MDG: Keeping its commitments to meet the MDG and the ensuing International Year of Sanitation (2008), the Federal Government came up with a very comprehensive strategy for scaling-up Rural Sanitation and Hygiene in It was realized that although the National Task Group on Sanitation was created in 2002, more work needed to be done to cover all critical components, at all levels, to scale up rural sanitation so as to meet the MDG. The scaling up strategy aimed to rectify this, particularly in the areas of harmonizing federal policies with State and Local Government approaches, facilitating integrated planning and target setting, supporting improved communication and advocacy for behaviour change and developing a menu of appropriate technology options. It was realised that at the prevailing rate of progress Nigeria could probably reach a coverage level of 49% where as the MDG (2015) expected this to be around 65%. Hence a target of constructing one million household latrines annually, during , was envisaged. CLTS Approach to sanitation: In order to accelerate sanitation coverage to meet the MDG, Nigeria was one of the first few countries in Africa to have resorted to the Community- Led-Total- Sanitation (CLTS) Approach in However wider application of this approach was adopted from 2008 onwards as a prelude to the International Year of Sanitation (IYS). The main objective of the CLTS approach was to empower the community, through a triggering exercise, to realize the extent and magnitude of the problems associated with open defecation and take necessary action collectively towards solving the problems for improved health and well-being of the people. It focuses on igniting a change in sanitation behaviour rather than constructing toilets. This is done through a process of social awakening that is stimulated by facilitators from within or outside the community. It concentrates on the whole community rather than on individual behaviour where the community resolves to make it open-defecation-free. Unlike the earlier subsidized sanitation program, CLTS is fully nonsubsidized. In Nigeria initially a scattered approach involving triggering communities all over the State was adopted. But soon it was realized that such an approach was not effective and hence an LGA-wide approach was introduced with encouraging results. As of July, 2014 CLTS has been initiated in all 36 States and FCT. Triggering has taken place in 19,467 communities of which 9,728 (around 50%) were declared ODF. Of this 3,276 (close to 34%) have been certified. 9

19 SECTION III: RATIONALE FOR A ROAD MAP The need for developing a road map for making Nigeria open-defecation-free by 2025 emanates from three principal factors. These are: - The benefits that Nigeria is losing every day due to a large number of people (50 million) defecating in the open. - Nigeria's lagging behind the milestone on sanitation coverage set by the Draft National Water-Sanitation Policy, Apprehension on meeting the MDG by 2105 and an open-defecation-free Nigeria by Nigeria's commitment to SDG-6 Goal and the PEWASH strategy A. Benefits from sanitation The multi-faceted benefits of sanitation are now well publicised through various studies/reports and review of documents. Even then it might not have reached all who matter. It will not be out of place to examine these findings for a better understanding and appreciation of what sanitation can contribute to the economy of Nigeria and why it should be one of the major priorities of the present Government. The health perspective: The impact of inadequate sanitation on the health of people in general and children in particular is now too well known. Diarrhoea is the second largest killer of children below 5 years in Nigeria, only next to Pneumonia. WHO says that 88% of diarrhoea cases are attributable to factors essentially originating from poor management of human excreta. According to a World Bank Report (2012), approximately 121,800 Nigerians, including 87,000 children under 5 die each year from diarrhoea nearly 90% is directly attributed to water, sanitation and hygiene. The adverse impact of open defecation can be judged from the fact that one gram of faeces of a person can contain 10,000,000 viruses, 1,000,000 bacteria, 1,000 parasite cyst and 100 parasite eggs and pathogens. If left in the open, these are carried by flies, fluid (water), finger and field (the famous four of the F-Diagram of disease transmission) and infect another person through the faecal-oral route. Hookworm, that enters the body through unprotected feet, has a direct link with open defecation. A very comprehensive literature review of 21studies, covering several countries (1991), found out a 36% reduction in diarrheal morbidity due to improved sanitation. In another review of lesser dimension carried out in 2004, such reduction was estimated at 32%. In a related practice pertaining to hand washing with soap at critical times (including hand washing after defecation) studies have shown a reduction of the diarrhoeal morbidity by over 40%. 10

20 The nutrition perspective: Children weakened by frequent diarrhoeal episodes are more vulnerable to malnutrition and opportunistic infections such as pneumonia. According to the NDHS (2013), 37% of Nigerian children below 5 years were stunted (height for age). Similar figures for wasted (weight for height) and under-weight (weight for age) were 18% and 29% respectively. The most distressing trend is that although the percentage of stunted children somewhat decreased from 42% in 2003 to 37% in 2013, the extent of wasting was worsened during the same period (an increase from 11% to 18%) and also underweight from 24% to 29%. According to Dean Spears, a well known Health Economist, a large part of malnutrition burden owes to the unhygienic environment in which children grow up. Poor sanitation accompanied by high population density act as a double whammy on children half of whom grow up stunted. In a study on the impact of sanitation on stunting, made in Ahmednagar district of Maharashtra (India), it was found out that on an average the height of children in the project villages had increased by about one cm compared to those in control villages. In the words of Dr Spears, wild spread child stunting is a human-development emergency in India and it matters for everybody. Hence the current thinking is that environment has a greater role in improving the nutritional status of a child than the diet. Questions are, therefore, now raised whether the large investments made in improving the nutritional status of children will produce the desired results without creating a safe environment for them. Iron deficiency anaemia (IDA) among adolescent girls is to a great extent linked to worm infestation for which the major culprit is open defecation. An anaemic mother, most likely, delivers a lowbirth-weight baby there by not only endangering life of the new born and but also can become a victim herself due to her poor health conditions. It is, therefore, not surprising that one in every fifteen Nigerian children dies before reaching his/her first birth day and one in every eight does not survive to see his/her fifth birthday. The Learning-Outcome Perspective: It is a known fact that a healthy child (physically fit and mentally alert) is expected to do well in learning than a sick child. Stunted children are generally admitted in school late and are less likely to complete their schooling. Tests have shown that a stunted child is less intelligent than their peers who are better nourished. Recent studies have shown that it is not diet but the adverse impact of poor sanitation and hygiene that contribute to stunting. Children with heavy worm burdens are likely to be absent for a greater proportion of the time than those who are lightly infected or free from worms. Also frequent sickness of a child can affect his/her learning achievements adversely. Adolescent girls are especially vulnerable to dropping out, as many of them feels reluctant to go to a school where there is no toilet for their privacy. There are empirical evidences, although limited, to show an increase in school attendance by girls where adequate sanitation facilities are available. A study conducted by Dasra, a strategic philanthropy foundation, in 15 Indian cities, revealed that almost 23% of girls drop out of school when they start menstruating. In some places, nearly 60 % of girls skip school during menstruation and onethird of them eventually drop out. A DPHE-UNICEF study in 1994 and 1998 in Bangladesh showed that provision of water and sanitation facilities in schools increased the girl's attendance by about 15%. In another study in Bangladesh by Water Aid, a school sanitation program increased girl's enrolment by 11%. Sanitation can contribute to the learning outcome of the children for which huge investments are made. 11

21 The social perspective: Open defecation is a social stigma, whether one likes it or not. Nothing is more disgusting than seeing the helpless young girls and women squatting in open. The dignity of women and girls is compromised without a latrine at home as they have to wait for the night or early hours to relieve themselves lest seen by others. The violence against young girls and even young married women in rural areas points at the social evil that is seen more and more in recent years. In Delhi (India) slums, a study by one NGO shows that 66% of women interviewed were verbally abused, 46% stalked and more than 30% were physically assaulted while going for the urgent call of nature. A study conducted by Water Aid in selected slums of Lagos in 2012 revealed the following - A quarter of women defecating in the open (as they did not have a latrine at home) had either first or second hand experience of harassment, a threat of violence or actual assault in the previous 12 months. - 67% of women felt unsafe using a shared or community toilet in a public place. - Only half of the women felt safe using a toilet in the local market. - 56% of women avoid using toilets at certain times of the day to avoid putting themselves at risk. If this is the situation in a mega city like Lagos, one can well imagine the plight of women and girls in smaller cities and rural communities. The economic perspective: The economic benefits of sanitation to an economy are not always well understood. This is mainly because of paucity and limitation of data on the subject. However, in recent years there is increasing realization of the cost and benefits of sanitation on making a country open-defecation-free. Some studies indicate that for every US $ spent on sanitation the return varies from US $ 9 to over US$ 40. In a desk study on the Economic Impact of Poor Sanitation in Nigeria, undertaken by the World Bank and published in 2012, it was estimated that Nigeria loses NGN 455 billion or US$ 3.6 billion annually due to poor sanitation. This amounts to US$ 20 per person in Nigeria per year or 1.3% of the national GDP. The loss to the country from some of the major components was estimated as follows. - US$ 243 million loss each year in Access Time, that is, the time lost in finding a suitable place for defecating. This cost falls disproportionately on women as care givers who may spend additional time accompanying children or sick or elderly relatives. According to the Water Aid Study mentioned above, 68% of women opined that the cost of using public toilet is a problem for them. - US$ 2.5 billion lost due to premature death every year. - US$ 13 million lost due to Productivity Losses whilst sick or accessing health care. This includes absent from work or school due to diarrhoeal diseases, seeking treatment from a health clinic or hospital and time spent caring for under-5s suffering from diarrhoea or other sanitation-attributable diseases. - US$ 191 million lost on health care. Costs associated with health seeking behaviour include consultation, medication, transport and in some cases hospitalization. The marketing perspective: The market potential of Sanitation Program in a country like Nigeria does not seem to have been understood. Presently in Nigeria 50 million people (or 10 million households) defecate in open. If we assume a very conservative cost estimate 12

22 of a pit latrine with slab to be NGN 25,000, the total market potential for material and labour will be worth NGN 1.25 trillion. If up-grading of the existing latrines and construction of institutional toilets are taken into account, the figure will shoot up further. According to the World Bank estimates, the annual growth of global sanitation market will be from US$ 6 billion in 2007 to US$ 14 billion in This can create a huge potential for employment both in production and service. B. Nigeria's lagging behind the milestones set by the National Water- Sanitation Policy, 2004 In spite of the efforts put in the past, sanitation coverage in Nigeria is still falling behind the expected targets. The country is yet to reach the various milestones envisaged by the Draft National Water-Sanitation Policy, As already mentioned, as per the Joint Monitoring Report (JMP) of WHO and UNICEF (2014), 23% of Nigeria's population were still defecating in the open and another 49% were using shared or traditional pit latrines in 2012 that were not considered improved by WHO. As per this report 39 million people were defecating in open. The latest data from NDHS (2013) put this figure at 50 million people or close to 10 million households. These figures do not include those who are sharing a latrine or using unimproved sanitary facilities like traditional pit latrines that are not considered as improved by WHO. If we add those using unimproved facilities, the figure goes up further. As per the JMP report, 31% of population in Nigeria were using improved latrines in This seems to have come down to 30% as per the results of NDHS However, the percentage of population defecating in the open has not reduced; instead, it has increased marginally from 22 in 2010 to 23 in 2011 and 2012, as per JMP but has gone up to 29% in 2013, as per the NDHS. This clearly indicates the challenges that the country is going to have to reach its goal to make it open-defecation-free. It is pertinent to note that Nigeria has around 123,240 communities. Of this the triggering under CLTS has been carried out in 19,467 communities that work out to less than 16% (Annex: 1). Covering the remaining communities will be a big task. Of the communities implementing CLTS, around half have declared ODF. However of this only 34 % have been certified. This only shows the challenge that lies ahead in covering all communities and making the certification process more efficient and effective. Another point that emerges from Annex 1 is the inter-state variation in terms of the adoption of the CLTS approach and its impact. While States like Zamfara (44), Plateau (56), Gombe (42), Edo (75), Delta (65), Borno (95) and Bayelsa (92) and FCT (98) have less than 100 communities implementing CLTS, in States like Bauchi (2200), Benue (1607), Katsina (1595), Kano (1569), Osun (1500) and Cross-River (1461), where WASH programs had been initiated by UNICEF, Water Aid and other agencies with support from DfID, EU, UNILEVER etc., a large majority of communities have been approached. A region-wide analysis of the progress of CLTS implementation, presented in Table -3, further brings out the status of CLTS in the six geo-political regions of the country. As may be seen from Table -3 the percentage of communities declaring ODF is highest in South-East (78%) followed by North-Central (65%) and North-East (57%). 13

23 The remaining three regions show lesser progress, in terms of communities declaring themselves as ODF. However, when it comes to the percentage of communities ultimately certified for ODF, the situation is somewhat different. Thus, North-East Region where only 30% of community reported ODF has the highest rate of certification (57%) where as South- East where 78% of communities reported ODF has the lowest certification rate (10%). Table -3 Region-wise Progress of CLTS Implementation (As of July, 2014) Region Total No. N No.of of LGAs Triggered Com. No. of Com. Declared ODF % No. of Com. Certified North- East North- West North- Central South- East South- West South- South National Source: Ministry of Water Resources, Abuja C. Apprehensions on meeting the Open-Defecation-Free Nigeria by 2025 and SDG-6 Nigeria had a commitment to meet the MDG of 65% sanitation coverage (improved sanitation) by It is now a foregone conclusion that Nigeria will not be able to meet this target. At the present rate of progress, even reaching the goal of open-defecation-free Nigeria by 2025 seems to be a far cry unless there are drastic shifts in the approach and strategy pursued in the past. It is a fact that if Nigeria cannot achieve the open-defecation-free target now set by the UN by 2025, Africa will not be able to achieve the same since Nigeria is the most populous African Country accounting for nearly one-fifth of Africa's population. According UN, 82% of the 1.1 billion people practising open defecation live in 10 countries and Nigeria is one of them. The others are India, Indonesia, Pakistan, Ethiopia, Nepal, China, Sudan, Niger and Mozambique. It is these compulsions that led the Federal Ministry of Water Resources to develop a road map for making Nigeria open-defecation-free by 2025 with the support of UNICEF. D. Challenges ahead If the objective is to make Nigeria open-defecation-free then the focus should be on those who are defecating in the open. This means even a traditional pit latrine should be acceptable although there would be room to climb up the Sanitation Ladder. Similarly, there should not be any open defecation in public places including schools, health centres etc. In this regard the definition of WHO on the use of sanitation facilities is worth examining. Open defecation: It is a condition where human faeces are disposed of in fields, forests, open bodies of water, beaches or other open spaces or disposed with solid waste. Unimproved sanitation facilities: These facilities do not ensure hygienic separation of human excreta from human contact. Unimproved facilities include pit latrines without a slab or platform (the traditional pit latrine), hanging latrines and bucket latrines. % 14

24 Shared latrines: This refers to those sanitation facilities that are of an otherwise acceptable type but shared between two or more households. Only facilities that are not shared or not public are considered improved. Improved: These facilities are likely to ensure hygienic separation of human excreta from human contact. They include the following facilities: - Flush/pour flush to i) piped sewer system, ii) septic tank, and iii) pit latrine (this could be on-site and off-site) - Ventilated Improved Pit Latrine (VIP) - Pit latrine with slab - Composting toilet Based on the above definition, the target for 2025 would be to stop people from defecating in fields, forests, open bodies of water, beaches or other open spaces or disposed excreta with solid waste. The Protocol for Certification and Verification of Open-defecation-free and Total Sanitation Communities in Nigeria also defines 'Open Defecation Free' status as follows. 'This (ODF) refers to when no faeces are openly exposed to the environment. Achieving ODF might involve the use of any form of latrines that prevent exposure of faeces to the environment with provision for moving up the Sanitation Ladder' As per United Nations Population Projection, Nigeria is likely to have a population of million by 2025 from the present level (2015) of million. This means an addition of million between 2015 and According to JMP Report (2015), million people in Nigeria were defecating in the open. This means the target for the population that should have access to a toilet by 2025 would be million ( additional population plus those million presently defecating in the open). The fact that between 2010 and 2011, Nigeria created access to latrine for 2.3 million people and 4.03 million people respectively (thanks to the push given under the CLTS strategy) would only indicate how big the tasks are to make the country open-defecation-free. In addition, provision of latrine facility and its use has to be ensured in all schools, health centres, markets, motor parks, jetties and religious places. For all this it is essential to look at the strategy adopted so far, find the gaps and develop a well-thought out road map to facilitate the goal of making Nigeria open-defecation-free by E. Lessons learnt from past efforts and problems associated with slow progress in sanitation coverage In recent years Sanitation has received a very high priority among the Government Programmes. As mentioned earlier there has been no sitting back on the part of the Federal, State and Local Governments to push the Program. Besides there has now been more frequent reviews and Round Table Conferences to discuss about the issues related to planning and implementation of the Sanitation Programme and the CLTS strategy adopted. Several studies have been carried out by the Government, UNICEF, Water Aid and others to understand the various aspects of the problem. It may not be out of place to put down the issues as revealed from the recent major findings of these reviews/studies to understand the 15

25 factors that are likely to come on the path of making the country open-defecation-free by Inappropriate technology options to meet the needs of various geo-physical conditions like loose and collapsible soils, high ground water level, flooded area, rocky terrain etc. - Lack of appropriate technology option to suit the preference of the people and their paying capacity - Slow pace in moving up the Sanitation Ladder - Lack of appropriate tools and methodologies for social mobilization, advocacy, demand generation and behaviour change - Inadequate skilled facilitators for effective scaling up of CLTS - Weak institutional arrangements and limited technical knowhow - Non-availability of effective alternate delivery mechanism - Low private sector participation in service delivery - Low involvement of NGOs and CBOs - Lack of understanding at all levels of the importance of sanitation and hygiene to public health, economy and protection of the environment - Lack of harmonization across many policies, implementation guidelines and tools for sanitation management - Low political and financial commitments - Absence of a suitable credit mechanism at community level to support sanitation - Inadequate follow up and monitoring by the LGA WASH Departments/ units due to irregular and inadequate financial supports from the LGA authorities and States - Poor documentation and record keeping of CLTS outputs at the LGA and State levels - Heterogeneous population groups in peri-urban and urban areas - Lack of adequate space, particularly in peri-urban and urban areas and the land tenure ship for constructing household latrines - Slow progress in promoting sanitation in schools, health centres market places etc. - Lack of uniformity in the provision for subsidy at household level 16

26 SECTION IV: SUGGESTED ROAD MAP AND STRATEGIES In order to address the problems raised above, a set of strategies with action points are suggested below. Technology options to suit different geo-physical conditions: Nigeria's most expansive topographical region is that of the valleys of the Niger and Benue valleys which merge into each other and form a "Y" shaped confluence at Lokoja. - cite_note-encarta-12 North to these valleys are plain lands. To the south-west of the Niger there is "rugged" highland and to the southeast of the Benue hills and mountains are found all the way to the border with Cameroon. Southwest and the southeast have coastal plains. The Niger delta that is located in the southern part of Nigeria is one of the world's largest fan-shaped river-delta. The riverine area of Niger delta is a coastal belt of swamps bordering the Atlantic Ocean. With such diversity in the geo-physical conditions, it is absolutely essential to develop suitable latrine designs that would not only be cost-effective, environment-friendly and easy to construct but also would be acceptable to people. In areas with high ground water, the conventional pit latrine is going to contaminate ground water used for drinking and hence not advisable. Similarly in flood affected areas, latrine with raised platform will probably be more suitable. Areas with loose and collapsible soils, a protected wall with cement rings or even drums could be an alternative with provision for adequate seepage. Effect of climate change should be taken into consideration in the design of appropriate technology options for the different geo-physical conditions in the country. In some areas communities have made attempts to address this issue with success by using local materials. But this is confined to a few communities. Efforts to bring further improvement on those local designs are too few and far between. The design and cost of a household latrine will vary significantly in areas with high water table, area frequented with flood, rocky areas, hilly areas and areas with loose soil formation. Hence together with the design, the cost options should also be worked out. This will call for developing a range of latrine designs for different areas and also within a given area. Cases where the cost is likely to be very high even for a simple design attempts should be made to work out the funding modality. 17

27 UNICEF had sponsored a study on this subject and the outcome has been a range of technology options for household latrines to suit different geo-physical conditions along with the costs. However, this has to be put in a simplified chart for better understanding among the functionaries at State and LGA level and also the WASH team to be used during their follow up activities. Action: 1. At national level a Technical Committee may be appointed to examine the options recommended for household latrines and suggests its adoption. 2. While dong so the affordability of the large majority of poor people may have to be taken into account besides the special needs of those physically challenged. 3. The committee may also develop designs for institutional latrines for schools, health centres, motor parks, market centres, jetties, religious places along with the bill of quantities and costs. 4. While doing so the innovations already carried out by communities and the designs already in use should be documented across the country and taken into account. 5. It is also expected of the Committee to suggest alternate options for superstructure for each design (s). 6. Experts from different regions and technical universities may be included in the Committee along with selected result-oriented implementers. 7. This should be done at the earliest preferably with in the first six month of 2015 so as not to lose time. 8. Once the designs are accepted, promotional materials pertaining to various options identified for a given geo-physical condition are developed for wider circulation. Technology Options to suit household's preferences and paying capability: Preference for a latrine design will depend upon the choice of household and at the same time the money that it could raise for the option so chosen. It can also be related to the social customs and beliefs prevalent in the community. This means even under a particular geophysical conditions more than one option could be possible to meet people's preferences. Such option could be pertaining to the basic latrine unit (without superstructure) or a basic unit with different superstructure. It could be one unit per household or more than one to take care of the social customs, if any among the family members. The socio-economic diversity of Nigeria is manifested in several ways. Nigeria is a heterogeneous country of more than 250 ethnic groups. Their social customs and beliefs are not always the same. As regards their economic status, although the per capita GDP of Nigeria in 2013 was estimated at US$ 3,010, there is wide disparity in income distribution among different population segments. Data available from World Bank shows that in 2011, 70.2 % of people in Nigeria earned less than US$ 1 a day that is considered extreme poverty. Information from the same source 18

28 indicates that in 2010 the lowest 20% of the people accounted for only 4.41% of income where as the highest 20% took away with over 54% of income (Figure -3). North-East, North-West and North-Central regions are relatively poor. Data available from the National Bureau of Statistics show that in 2007 the incidence of poverty in these three regions was 72.2%, 71.2% and 67.0% respectively; the country average being 54.4%. Similarly, the rural-urban differential in the incidence of poverty is also quite pronounced; 63% of rural people are below poverty level as compared to 43.2% among their urban counterpart. It is also noticed that presently agriculture, the main occupation in rural areas are looked after by the old as the young have migrated to urban areas in search of greener pasture. The literacy level of these people is low so also is their attitude towards life. All these factors justify why there should be a range of latrine options to meet the demand from the people with diversified socio-economic characteristics. In 2013 UNICEF had sponsored a Sanitation Marketing Study in six States, viz., Katsina, Benue, Jigawa, Cross River, Anambra and Osun. The purpose was to assess people's opinion on use of latrine with diverse socio-cultural, religious and economic conditions across the country. The findings of this study, presented below, are worth looking at for a better understanding of the issues. - 85% of respondents were willing to stop open defecation and majority would like to construct a pit latrine with slab followed by water closet. - 50% of respondents were willing to pay for improved sanitation. - 73% of respondents were aware of other type of toilet facilities. - Half of the respondents expressed their willingness to pay N2,000 to N5,000 for toilet construction. - 63% were willing to use public toilets - And most of them were willing to pay between N10 and N20 per use. These findings do indicate that most people irrespective of their socio-economic status are inclined to stop open defecation. However their ability to pay differ. Figure 3: Distribution of Income, Nigeria Percent of Total Income Poorest Quintile of Population Richest 19

29 Action: 1. Communication materials on latrine designs, as suggested by the Technical Committee, should be appropriately developed to give a household choice of various options. 2. Social customs and beliefs may vary significantly within a State. It will therefore be appropriate to use the local knowledge and build on those customs and beliefs. 3. In difficult areas where the cost of constructing a latrine may be beyond the capacity of a household, introducing appropriate credit mechanism may have to be thought of. 4. Public toilets should be encouraged only where space is a big problem like periurban and urban areas and market places and these should be pay and use type. In all other cases construction of household latrines should be encouraged depending on the willingness of the households, in terms of their preference and capacity to pay. Sanitation Ladder: It is of common knowledge that at any given point of time, households will be using different types of latrine based on their choice and affordability. As the socioeconomic status of a household increases and with that the life style, there will be, most likely, a shift in upgrading the existing latrine as it does for other household utilities. The open-defecation-free condition implies the absence of any excreta in open. For this purpose even squatting on a whole and covering it amounts to an open-defecation-free condition. From that to a flush toilet connected to a septic tank or sewer, there could be a range of options for safe disposal of excreta that could be thought of. It is something like climbing a ladder from a low cost option to a high cost option (Figure -4). The Sanitation Ladder helps people to identify options for improving sanitation in their community and realize that this can be a gradual process. Explaining the concept of Sanitation Ladder helps people to i) describe the community's sanitation situation, ii) identify options for improving sanitation and iii) discover that improvements can be made step by step. The idea that a community can progress up the ladder at different rates can be very appealing to the people. Experience in many Asian countries has shown that sometimes ignorance of the people with regard to the pros and cons of having a particular latrine is responsible for households to delay the decision to upgrade their existing latrine or even construct a latrine. It is, therefore, essential that people are made conversant with how to upgrade their latrines in line with their socio-economic status and life style. 20

30 Figure 4: Moving up The Sanitation Ladder Improved Unimproved Unimproved sanitation facilities Shared sanitation facilities Improved sanitation facilities Improved sanitation facilities: are likely to ensure hygienic separation of human excrete from human contact. They includefollowing facilities: Flush/pour flush to Piped sewer system Septic Tank Pit latrines Ventilated improved pit (VIP) latrine: Pit latrine with slab Composting toilet Shared sanitation facilities: Sanitation facilities of an otherwise acceptable type shared between two or more household. Only facilities that are not shared or not public are considered improved. Unimproved sanitation facilities: Do not ensure hygienic separation of human excrete from human contact. Unimproved facilities include pit latrines without a slab or patform, hanging latrines and bucket latrines. Open Defecation Open Defecation: When human faeces are disposed of in fields, forests bushes, open bodies of water, beaches or other open spaces or disposed of with solid waste. It may not be uncommon to see people jump several steps in the Sanitation Ladder once they become aware of the different options. For example the KAP study on WASH sponsored by UNICEF, Nigeria in 2008 in FCT and six other States gives the following interesting findings on this issue. - More than two-thirds of the households conveyed their willingness to pay for improvement of the sanitation facilities now available at home. - In FCT, Kaduna and Kogi, although majority of the households were either defecating in the open or using the traditional pit latrines, they want to jump the ladder and would like go for pour flush latrine. - This is different in Zamfara, Sokoto and Kebbi where only a small proportion of households wanted to opt for a pour flush latrine and preferred the Sanplat type. It was not clear whether the study tried to find out the knowledge of the households interviewed on the features of different latrines and their cost. In its absence it could be presumed that imparting the latrine options available to the households of Zamfara, Sokoto and Kebbi probably could have influenced their preference. The same study shows that more than two-thirds of the households conveyed their willingness to pay for improvement of the sanitation facilities now available at home. It is here that the Sanitation Ladder concept comes handy. The Sanitation Ladder that shows how improvements can be made step by step will be very appealing to the community. Community members soon realize that progress could be made over time and at a pace that is appropriate to them. On the perception of a good latrine, the same study found out privacy (50.5%), ability to prevent diseases (43.45%) and safety (33.8%) as the major responses from the households. How to link these opinion and perceptions in Sanitation Ladder so as to facilitate a conscious 21

31 decision by a household will be a challenge. The financing mechanism has also to be linked with it so that preference for a particular type of latrine is supported by ability to pay, either from one's own funds or through credit. Action: 1. Before the concept of Sanitation Ladder is introduced to the community it would be essential to have information on: - Design principles of different sanitation options - The effectiveness of different options and the benefits - The use and maintenance of different options - The cost of different options - The durability and sustainability of different options 2. It will be necessary to have a very clear idea on where to get the materials and technical advice on the options so identified. 3. There should be one page showing all the options in a sequence and one page for each option depicting what is mentioned at items 1 and 2 above. Pour-flush toilets using less water as a low cost option: As seen earlier, among the latrine users, majority are currently having the traditional pit latrine that is not considered as improved by WHO. Also many households want to start with a higher option. It is pertinent to note that cleaning and disposing off the raw excreta from a traditional pit latrine or a Sanplat latrine or even a VIP latrine is a major problem especially in peri-urban and urban areas. Absence of cess pit emptier and availability of a safe spot to off-load the raw excreta poses serious problem. Even in FCT area this is a problem. Results of the KAP study, referred to above, indicates while privacy is perceived as the most important factor for a good latrine (50.5%), factors like safety, prevention of disease, and cleanliness were also perceived as the characteristics of a good latrine. Since flush toilets are at the top of the Sanitation Ladder, it may appear very costly. But it is not always so. While flush latrines, linked to a sewer line or a conventional septic tank, could be quite costly, simple pour-flush latrines with a single pit (on-pit) or two pits (off-pit) to be used alternatively can be less costly than the VIP latrines. The problems of flies, mosquitoes and smell in simple pit latrines and even in Sanplat can be overcome simply and cheaply by the installation of a pan with water seal in the defecating hole. The pan is cleaned by pouring around two litres of water after each use. The flushing water need not be clean. If access to clean water is limited, laundry, bathing or any other similar water could be used. These latrines are most appropriate for people who use water for anal cleaning and hence could be popular in Nigeria. These toilets also do not need any vent pipe since the gas produced in the pit easily percolates into the surrounding wall. Pour flush latrine could be mainly of two types, one where the pan is fixed on the hole (Figure - 5) and another where the pits will be away from the pan. Called Off-site Dual Pit Four Flush Toilets, this type of latrines have two pits to be used alternatively (Figure 6). The pits are generally of one meter deep and it takes four to five years for a family of 5 members to get it 22

32 M A K I N G N I G E R I A O P E N - D E F E C AT I O N - F R E E BY filled up, enough time for the excreta to get free from pathogens and virus. In this way these latrines are very hygienic. Figure 5 Sketch of Single Pour-flush Latrine (Floor slab fitted with a water seal pan) Features: The cheapest kind of sanitary toilet. No flies no odour. Pit need not be lined if the soil is form but if the soil is sandy and loose, then the pit will have to be lined with cement rings, or blocks. Even in the case of one pit pour flush latrine, once the pit gets filled up it can be covered with soil to turn into compost; and the unit could be shifted to a new location to be brought back again to the same spot after cleaning the earlier pit that would not be hazardous to handle. The platform could be rectangular or circular, although the latter is generally recommended. The pan could be cement, mosaic, and ceramic or fibre glass with a steeper slope and a 20 mm water seal needed to flush out the excreta with minimum water of one and half to two litres. 23